A few months ago, my husband’s old herniated disk injury flared up, and the shooting pain in his leg made it difficult to walk. He was sure he’d need another operation on his spine, but his doctor proposed a less invasive approach. She prescribed a new medication for his nerve pain, told him to take a break from five-mile runs and suggested he try yoga. Despite being skeptical that yoga would relieve his pain, he was open to the suggestion. The problem was he wasn’t sure how to “try yoga.” Was he supposed to do a certain type for back injuries? And how often?
Yoga arrived in the U.S. at the turn of the 20th century. Though initially embraced as a countercultural practice, it eventually emerged in mainstream fitness. Today, a growing body of research depicts yoga as a valuable supplement to Western therapies for conditions including chronic pain, hypertension and depression. In addition to its apparent health benefits, yoga is notable for what it lacks: dangerous side effects, high abuse potential and drug interactions. But doctors aren’t always familiar enough with the practice to offer a more specific recommendation than “try yoga.” When someone is taking up yoga for a medical reason, the specifics matter.
Jennifer Daks’s rheumatoid arthritis reemerged when she was 18. The now 27-year-old psychology graduate student had been diagnosed with the autoimmune condition as a child, but she spent most of her teenage years in remission. With the disease back in her life, Daks was desperate for new ways to mitigate the debilitating pain that comes with it. “I was barely able to get out of bed or open the refrigerator,” she said. “I felt like I was 100 years old in an 18-year-old body.”
Her rheumatologist suggested yoga to complement her cocktail of prescription meds, but couldn’t tell her how to select the right class. In the first class Daks tried, she was told to do child’s pose, a yoga posture that in its traditional form requires kneeling. The instructor described the pose as “restorative.” For Daks and her tender knee joints, it was excruciating.
She didn’t give up on yoga, but it took Daks five years to find the right practice: a gentle class, where the instructor urges students to listen to their bodies’ pain signals and offers modifications to make poses more accessible.
Daks’s mounting interest in yoga eventually led her to Steffany Moonaz, a yoga instructor and researcher who serves as director of clinical and academic research at the Maryland University of Integrative Health.
To date, studies support the benefits of yoga for back pain, arthritis, depression and insomnia. Moonaz says yoga is safe for people with these and many other health issues, provided they choose an appropriate, well-designed practice — that is, a practice like the one Daks eventually found, one with poses that can be modified to accommodate the limitations of individual students. Unfortunately, that doesn’t always happen. The incidence of yoga injuries is higher than it should be, which Moonaz attributes at least in part to the varied levels of training and experience across instructors. There’s also the fact that classes called “yoga” vary widely, from gentle practices to ones that would be challenging for people with serious health concerns.
People with injuries, chronic conditions and other physical limitations should probably steer clear of the highly Instagrammable classes frequented by the headstands-on-a-canyon crowd. Instead, they should look for classes where instructors supply props, such as supportive blocks and bolsters, and help students find comfortable and pain-free versions of standard poses.
It’s also a good idea to ask your doctor or physical therapist if you should avoid any specific physical positions or movements, says Dr. Baxter Bell, a yoga therapist and former family physician who cofounded the blog Yoga for Healthy Aging. He notes that doctors unfamiliar with yoga might have no idea what postures are likely to come up in class, so don’t expect them to tell you the actual names of poses to avoid. What they can offer is helpful safety guidelines, such as whether a herniated disk means you should completely avoid forward bends or whether it’s okay to stretch an injured hamstring yet.
Any practice undertaken for healing purposes, Moonaz says, should also include more than just physical yoga poses, or asanas. Breathing practices, or pranayama, and meditation should be part of the equation too. Practicing the physical poses along with pranayama and meditation turn yoga into a powerful mind-body practice. The stress relief provided by mind-body practices is particularly important for people managing an illness or pain. That’s because the psychological toll of having a medical condition can worsen someone’s perception of their physical symptoms and make them feel even worse. On the other hand, a yoga practice designed to reduce stress could diminish the intensity of those physical symptoms.
There are also yoga practices and even entire studios geared toward students with various ailments. In her own work, Moonaz has focused on arthritis. She coauthored the forthcoming book Yoga Therapy for Arthritis and created a guide to help arthritic students navigate a variety of popular and therapeutically beneficial styles.
One of those, Iyengar yoga, is widely offered throughout the U.S. and has been frequently used in studies. It focuses on precise physical alignments. It’s also a form of yoga that, because of its use of props, can be easily adapted to suit the needs of students with chronic pain or other injuries.
One Iyengar instructor, for example, initially took classes in his 20s to overcome a bout of back pain, before eventually leaving his office job to train in the method. A decade later, he teaches at a Manhattan studio where all classes are designed with back pain sufferers in mind.
Another teacher, now in her 40s, began taking Iyengar classes decades ago to keep herself strong and injury-free while working a physically demanding job. Five years ago, she was diagnosed with an autoimmune disorder called mixed connective tissue disease. Her medical condition led her to Moonaz’s work on arthritis for yoga, as well as research on the benefits of aquatic exercise for patients with joint pain. While her classes are still influenced by her Iyengar studies, she now specializes in teaching a pool-based form of yoga.
A good way to look for a suitable yoga class is to search the Yoga Alliance, a professional organization for yoga instructors. After locating a teacher in your area, you can further refine your results by the type of class the teacher specializes in, such as “gentle yoga,” implying a slower-paced class, or “alignment-focused,” suggesting the teacher will provide instruction on precise physical alignment, often with the use of props.
In addition to finding an appropriate yoga class, patients with serious medical conditions might consider working one on one with a yoga therapist. This is an emerging healthcare field akin to physical therapy. Yoga therapists are professionals with extensive training who use yoga techniques to help patients with specific medical concerns.
Still, many people find value in the social support provided by group classes. Daks, for instance, says a primary benefit of the Yoga Therapy for Arthritis training she attended was the opportunity to meet other young people with arthritis, a disease often associated with aging.
My husband, on the other hand, preferred a more solitary, home-based practice. As a trained yoga teacher, I was able to offer him the instruction that other patients told to “try yoga” might not receive. I encouraged him to try the “Back to Health” protocol developed at Boston Medical Center, designed specifically for patients with back conditions. His doctor was right: His condition did improve, without surgery. And his break from running is over.